Dynamic Hyperinflation and Exercise Intolerance in Chronic Obstructive Pulmonary Disease
Abstract
The role of dynamic hyperinflation (DH) in exercise limitation in chronic obstructive pulmonary disease (COPD) remains to be defined. We examined DH during exercise in 105 patients with COPD (FEV(1) = 37 +/- 13% predicted; mean +/- SD) and studied the relationships between resting lung volumes, DH during exercise, and peak oxygen consumption (VO(2)). Patients completed pulmonary function tests and incremental cycle exercise tests. We measured the change in inspiratory capacity (Delta IC) during exercise to reflect changes in DH. During exercise, 80% of patients showed significant DH above resting values. IC decreased 0.37 +/- 0.39 L or 14 +/- 15% predicted during exercise (p < 0.0005), but with large variation in range. Delta IC correlated best with resting IC, both expressed %predicted (r = -0.50, p < 0.0005). Peak VO(2) (%predicted maximum) correlated best with the peak tidal volume attained (VT standardized as % of predicted vital capacity) (r = 0.68, p < 0.0005), which, in turn, correlated strongly with IC at peak exercise (r = 0.79, p < 0.0005) or at rest (r = 0.75, p < 0.0005). The extent of DH during exercise in COPD correlated best with resting IC. DH curtailed the VT response to exercise. This inability to expand VT in response to increasing metabolic demand contributed importantly to exercise intolerance in COPD.
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In patients with COPD, exhalation may not be completed prior to the onset of the next breath, causing an increase in operational lung volumes and progressive air retention called air trapping.
“As a result, exhalation may not be completed prior to the onset of the next breath, causing an increase in operational lung volumes and progressive air retention called “air trapping”.13,26,34”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [13]
Exercise intolerance and lung hyperinflation are closely interrelated in COPD.
“Despite the difficulties in establishing a cause-effect relationship, exercise intolerance and lung hyperinflation are closely interrelated in COPD.13,14”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [13]
When comparing two patients with similar FEV1, the one presenting with a reduced diffusion capacity, more severe small airway obstruction, and a higher ventilatory response to exercise will tend to develop more dynamic hyperinflation early during exercise.
“However, when comparing two patients with similar FEV1, the one presenting with a reduced diffusion capacity, more severe small airway obstruction, and a higher ventilatory response to exercise will tend to develop more dynamic hyperinflation early during exercise.13”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [13]
A small proportion of patients with COPD (~15%-20%) do not dynamically hyperinflate during exercise even though they still experience intolerable dyspnea.
“Although dynamic hyperinflation is a cardinal feature of COPD with important physiological consequences, a small proportion of patients (~15%–20%) do not dynamically hyperinflate during exercise even though they still experience intolerable dyspnea.13,42,57”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [13]
In a larger cohort of COPD patients (n=105), the VT/IC ratio was the strongest predictor of exertional dyspnea based on multiple linear regression analysis.
“A subsequent study in a larger cohort of COPD patients (n=105) demonstrated that the VT/IC ratio, an index of EILV and VT constraint, was the strongest predictor of exertional dyspnea based on multiple linear regression analysis.13”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [13]
Peak VT relative to predicted vital capacity was the best predictor of peak aerobic capacity (r=0.68, P<0.0005) in 105 patients with COPD.
“For example, peak VT relative to predicted vital capacity was found to be the best predictor of peak aerobic capacity (r=0.68, P<0.0005) in 105 patients with COPD.13”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [13]
More than 80% of patients with moderate-to-severe COPD showed significant increases in EELV during exercise.
“More than 80% of patients with moderate-to-severe COPD showed significant increases in EELV during exercise.11,13,46,150”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [13]
Cites
O'DONNELL, D. E., LAM, M., & WEBB, K. A. (1998) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.158.5.9804004 · Cited by 532 · see citing works
Self-citationBelman, M. J., Botnick, W. C., & Shin, J. W. (1996) · American journal of respiratory and critical care medicine · doi:10.1164/ajrccm.153.3.8630581 · Cited by 402 · see citing works
Diaz, O., Villafranca, C., Ghezzo, H., Borzone, G., Leiva, A., Milic-Emil, J., & Lisboa, C. (2000) · European Respiratory Journal · doi:10.1034/j.1399-3003.2000.16b14.x · Cited by 300 · see citing works
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Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., Hill, K., Holland, A. E., Lareau, S. C., Man, W. D.-C., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201309-1634st · Cited by 3,938 · see citing works
ATS/ACCP statement on cardiopulmonary exercise testing
(2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.167.2.211 · Cited by 3,026 · see citing works
American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation
Nici, L., Donner, C., Wouters, E., Zuwallack, R., Ambrosino, N., Bourbeau, J., Carone, M., Celli, B., Engelen, M., Fahy, B., et al. (2006) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200508-1211st · Cited by 1,966 · see citing works
Self-citationParshall, M. B., Schwartzstein, R. M., Adams, L., Banzett, R. B., Manning, H. L., Bourbeau, J., Calverley, P. M., Gift, A. G., Harver, A., Lareau, S. C., et al. (2012) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201111-2042st · Cited by 1,844 · see citing works
Self-citationEffects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD
O'Donnell, D. E., Flüge, T., Gerken, F., Hamilton, A., Webb, K., Aguilaniu, B., Make, B., & Magnussen, H. (2004) · European Respiratory Journal · doi:10.1183/09031936.04.00116004 · Cited by 859 · see citing works
Self-citationConsequences of exercise-induced respiratory muscle work
Dempsey, J. A., Romer, L., Rodman, J., Miller, J., & Smith, C. (2006) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2005.12.015 · Cited by 398 · see citing works
O'Donnell, D. E., Voduc, N., Fitzpatrick, M., & Webb, K. A. (2004) · European Respiratory Journal · doi:10.1183/09031936.04.00072703 · Cited by 365 · see citing works
Self-citationWearable and flexible sensors for user-interactive health-monitoring devices
Ha, M., Lim, S., & Ko, H. (2018) · Journal of Materials Chemistry B · doi:10.1039/c8tb01063c · Cited by 352 · see citing works
Pulmonary characteristics in COPD and mechanisms of increased work of breathing
Loring, S. H., Garcia-Jacques, M., & Malhotra, A. (2009) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00008.2009 · Cited by 246 · see citing works
Regional chest wall volumes during exercise in chronic obstructive pulmonary disease
Aliverti, A. (2004) · Thorax · doi:10.1136/thorax.2003.011494 · Cited by 226 · see citing works
Physiology and consequences of lung hyperinflation in COPD
O'Donnell, D. E., & Laveneziana, P. (2006) · European Respiratory Review · doi:10.1183/09059180.00010002 · Cited by 223 · see citing works
Self-citationThe major limitation to exercise performance in COPD is dynamic hyperinflation
O'Donnell, D. E., & Webb, K. A. (2008) · Journal of Applied Physiology · doi:10.1152/japplphysiol.90336.2008b · Cited by 221 · see citing works
Self-citationDyspnea and Activity Limitation in COPD: Mechanical Factors
O'Donnell, D. E., & Laveneziana, P. (2007) · COPD: Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412550701480455 · Cited by 220 · see citing works
Self-citationPathogenesis of hyperinflation in chronic obstructive pulmonary disease
Saey, Gagnon, P., Guenette, J., Langer, D., Laviolette, L., Mainguy, V., Maltais, F., & Ribeiro, F. (2014) · International Journal of Chronic Obstructive Pulmonary Disease · doi:10.2147/copd.s38934 · Cited by 180 · see citing works
“Despite the difficulties in establishing a cause-effect relationship, exercise intolerance and lung hyperinflation are closely interrelated in COPD.(13,14) While exercise intolerance in patients with COPD is complex and multifactorial, dynamic hyperinflation remains a major contributor to exercise limitation that is c…”
InfluentialOra, J., Laveneziana, P., Ofir, D., Deesomchok, A., Webb, K. A., & O'Donnell, D. E. (2009) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200904-0530oc · Cited by 139 · see citing works
Self-citationMüllerová, H., Lu, C., Li, H., & Tabberer, M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0085540 · Cited by 139 · see citing works
Berry, M. J., Justus, N. W., Hauser, J. I., Case, A. H., Helms, C. C., Basu, S., Rogers, Z., Lewis, M. T., & Miller, G. D. (2015) · Nitric Oxide · doi:10.1016/j.niox.2014.10.007 · Cited by 134 · see citing works
Peters, M. M. (2006) · Thorax · doi:10.1136/thx.2005.053470 · Cited by 128 · see citing works
Effect of obesity on respiratory mechanics during rest and exercise in COPD
Ora, J., Laveneziana, P., Wadell, K., Preston, M., Webb, K. A., & O'Donnell, D. E. (2011) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01131.2010 · Cited by 101 · see citing works
Self-citationVaes, A. W., Franssen, F. M. E., Meijer, K., Cuijpers, M. W. J., Wouters, E. F. M., Rutten, E. P. A., & Spruit, M. A. (2012) · PLoS ONE · doi:10.1371/journal.pone.0041078 · Cited by 8 · see citing works
- Authors
- O'DONNELL, D. E., REVILL, S. M., & WEBB, K. A.
- Affiliations
- Respiratory Investigation Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Queen's University (CA)
- ORCID
- WEBB, KATHERINE A.
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2001-09-01
- Volume
- 164
- Issue
- 5
- Pages
- 770-777
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W1981434879
- Cited by
- 1,076
- References
- 3
- Citations by year
- 2026: 23 · 2025: 29 · 2024: 26 · 2023: 30 · 2022: 33 · 2021: 35 · 2020: 50 · 2019: 41 · 2018: 56 · 2017: 43 · 2016: 46 · 2015: 48 · 2014: 51 · 2013: 47 · 2012: 65
- FWCI
- 20.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- dynamic hyperinflation, chronic obstructive pulmonary disease, exercise intolerance, inspiratory capacity, peak oxygen uptake, tidal volume, lung volume, exercise limitation
- MeSH terms
- Aged, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Exercise Tolerance, Pulmonary Disease, Chronic Obstructive
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